Main menu

Monthly Archives: September 2010

Post navigation

Remember when Nellies on 17th was 5 tables and you didn’t have to wait in line? Remember when it was you and a few other freaks that knew about the joys at eating breakfast after a late night and various diversions? Remember when eating breakfast out was something done by truckers and a few other people working in the late night entertainment industry?

Breakfast out has become a norm of the culture now. It is grandparents, small children, hung-over classmates, singles, families and all sorts in between.

Used to be Smitties for pankcakes, now there is a wide assortment of choices from the expanded Nellies and the trendy Coras to buffet at the MacDonald’s. (not the fast food place)

We are a weird culture. We take our fringe-dweller’s activities and turn them into standard family fare. Just watch, I’m betting we see body modification children soon

On occasion I have been known to find social actions that bug the shit outta me. However, I feel it is always important to find something good in the experience to balance out the irritation, cause I know, that when there is no balance I become unbalanced and THAT my friends is not a pretty sight. Walmart incident. Say no more.

So just this week I found myself off at another local hospital for a course. I used to work at this hospital but haven’t been back over for years. It is a smaller, religion-run hospital that was always, except for the oppressive prayer overhead each morning at 0800, not such a bad place to work.
I had forgotten about the cheese buns. This hospital maintains a kitchen staff that can bake and cook real food. Each Friday they have a cheese bun tradition. These most excellent kitchen staff (I envision them as Nuns in full habit) create these heavenly cheese buns. Yeasty and warm and full of cheesy goodness, these buns are and have been the motivation for many staff to get out of bed and show up at work Fridays. And so in honour of the kitchen nuns and years of working Fridays, I had myself a cheese bun and reminisced about all the cheese buns I have had before sitting in the cafeteria. Cheese buns took me to CAB buns…remember the joy of those early morning delights before class? Generations of students have risen still dreaming, cinnamon drawing them from their student hovels to provide a very good reason to be darting from building to building in search of knowledge and CAB buns. Crunchy on top, gooey cinnamon on the inside, best served warm with as many pats of butter you could steal.

Like all good experiences the cheese buns gave rise to another experience to balance out the cheesy joy. The obtaining of change when paying for goods. It used to be, in days gone by, that when you bought something you received your change into your hand counted out. I remember sweating over the whole learning to count dollars and cents from the price of purchase so that the customer knew and could see that you had given then the correct change and THEN they put the bills in your hand as part the counting out and showing you that they had given you the correct change. No more. Change is either dumped in your hand, bills first and then a hand full of change that slips and slides invariably off the bills and out of your hand, OR dumped on the counter in front of your outstretched hand.

What the fuck is the point of that? The money is dirtier than my hand can ever get, so why can’t you put the change in my hand?

And while you are at it, make eye contact with me so I know you are aware that I exist. Learn some basic customer service. It’s not hard, it makes your job more enjoyable to YOU the minimum wage earner and ultimately, if I remember you as someone who provided good service you will benefit from it.

Add to my cheesy bun experience and I will add to your minimum wage experience. See, we all benefit when you act like a human being.

Drinking behaviours often result in a multitude of relationship breakdowns. This is not isolated to our primary significant other relationships, but also friends, work, business and complete stranger relationships. As humans we relate to others on a daily basis – unless you’ve elected to be the hermit in the hill, live in a cave and survive on roots and berries.

So as a personal development tool to insight on your own potential interrelationship red flags, screen all the photos of you posted online. Count up the number of photos of you online (TP). Now count up the number of photos of you with an alcoholic drink in hand (AD). Now divide the AD by the TP and multiply by 100. That will provide you with your index of possible social event relationship difficulty. If the index is greater than 50% you are in the potential problem grouping. If it is greater than 75% you are in the always a problem grouping.

If there are ANY photos of you involved in something like this, immediately add 25 points to your AD number.

Alternatively, if you look like this in any of your photos, recognize that you have a problem and seek help immediately. It’s not too late.

As a final act of humility, google yourself and any online user names you have used. Brrr. Chilling.

Remember reflecting on who we were is the best way to move towards who we want to be.

Parents put sleeping through the night as an early childhood goal. As soon as the bundle of joy is home from the hospital and the new parents are bleary-eyed and trying to maintain a semblance of hospitality to an insensitive friend or family member, they will hear tales of how ‘my Torrent slept 18 hours straight when he was three days old’. (I’ve always view those children as perhaps just a little dimmer than the rest). Or they will hear from the equally insensitive about how little Desil has NEVER slept through the night in his entire 34 years.

The point being that we value sleep, long for it and yet it eludes so many. Now the sleep experts (and yes, would that be a great job or what?) tell us that 30%-50% of the population has some form of insomnia but only 10% experience chronic insomnia. Insomnia meaning ‘in want of sleep’ has classifications of course, and is a symptom not a condition or disease. There is the ‘I can’t fall asleep’ type, the middle-of-the-night insomnia and middle insomnia are splitting hairs over the definition – the hyphenated type wakes up for some other reason and can’t get back to sleep and the middle type wakes up for no reason and can’t continue sleeping – bottom line, both are awake in the middle of the night and wondering WTF. They can’t stay asleep. And then there is the terminal insomnia which makes it sound like some sort of death thing but in reality it is simply that you wake up a lot earlier than you think you should.

My prefered insomnia expression seems to be the staying asleep kind, though it could be arguably the terminal but I’ll be damned if I am getting up at 4 am. For years it was 3am consistently, like clockwork so I suppose the 4am is an improvement. What is going on at 3 am or 4 am that I need to be awake for? Nothing, it is quiet outside. All the loud street walking drunks are home or curled up in a ditch somewhere. No buses, few vehicles even the cat is deep asleep, yet I am wide awake.

I have tried everything during my many years of sleep disturbances. When I worked shift it was a crisis to make sure I got sufficient sleep to function at work – I never did. I tried all sorts of drugs, prescription and otherwise, diet, exercise at the appropriate times and inappropriate times, heavy meals, light meals, no caffeine, some caffeine, white noise, ear plugs, sleep masks, cool room, different pillow, melatonin, sleepytime tea, tryptophan – you name it, I’ve tried it. And nothing will help keep me asleep through the night.

Except ibuprophen. Yes, that’s correct. 400mg of good old ibuprophen at bedtime and I will sleep like I want to. Weird or what? But now I’ve been told that a daily ibuprophen habit is risky due to GI bleeding. Just when you find a cure it becomes another disease.

It could be worse I suppose. There is (was?) a farmer in Vietnam who claims to have not slept in 35 years! I am not visited by incubus or night demons intent on sucking dry my soul.

And this? only makes me wonder, but not too long, about what sort of messed up childhood these two had.

And then there is the other possibility. There exists out there in the weirdness of being alive, the phenomenon of sleep state misinterpretation. Which basically means you think you are not asleep but you really are you idiot.

Every single day hundreds of thousands of patients seek health care and every day something goes wrong. Often it is small things that make the process more difficult, more complicated and more frustrating. Each day patients come to understand that their experience with the health care system will be unreliable.

A patient sees a doctor and a specific laboratory test is recommended. A requisition is received and the patient books the time with the lab to do the test. By consulting with the lab at booking time the patient finds out what the necessary prep is for the test and follows those instructions. The patient arrives at the lab at the arranged time for the expected test only to be told that this is the wrong requisition and that if they don’t have the correct one from the doctor the patient will have to pay for the test.

The laboratory tech tries to be helpful by calling the physician’s office to get the correct requisition faxed over. The physician is not there and may not be there for a couple days. The office staff identifies that he has made this mistake before. They will get him to complete the correct requisition and fax it over when he returns to the office.

So the patient, who has likely taken time aways from work or other obligations, has a choice to pay for the test out of pocket, reschedule as some unknown time in the future, or say to hell with it.

Unfortunately there were many points in this process that could have changed the outcome to complete lab work. At the physician’s office the office staff gave the patient the requisition – they could have checked it and noted what was being requested and noted that it was the wrong requisition. The physician could have been aware of the specifics of this test. The insurance company could deal with their billing issues internally instead of requiring the physician and the patient to ensure that their billing of this test goes through correctly. When the patient called the lab to arrange the test they could have checked that the correct requisition was in hand. The office staff could have faxed in the correct requisition using a physician signature stamp. The lab could provide the information about correct requisition requirements on their website.

Any of these actions could have changed the outcome, but in the complexity of the health care system it often comes down to the patient being responsible to ensure that all the processes are followed through with correctly. How do patients come to understand what they need to do to make sure that what happens is what is suppose to happen? Are there some ways we, in the profession, can make sure that patients do not bear the brunt of our inefficiency and unreliable processes?

Or maybe we can just be satisfied that patients survive in spite of what we do

I have a migraine today. It is a fairly bad one, or at least worse than many and I noticed a few more symptoms as part of the constellation. Colours hurt, the secretary’s voice was a sound from the depths of hell and the office lights were akin to the tortures of having my brain scrubbed with a wire brush.

Now, you may ask, if you have a migraine why are you on the computer? And this is a good, valid question. I left work after a couple of hours with the headache to come home after all, unable to work. I tried tea, coffee, food, sugar, chocolate, dark room; all without success. Finally I succumbed to medication, and after a couple of hours nap, I now sit cotton mouthed and perhaps symptom free at my computer. Ever curious, I want to find out what exacerbates or brings on the migraine event for I know it sits, there, just out of my field of vision, ready to pounce again.

Many believe a migraine to be a headache, but it is much more than that. Part headache, part neurological event; migraines are, for many an out-of-body experience without any spiritual insight. Complete with an aura, a migraine is often closer to a seizure than a headache and today, I discovered that the aura experience for me can also include behaving in a socially awkward manner. Followed by a somewhat whiny, querulous manner. Neither of which are attractive, favoured presentations of a health care professional – or anyone else.

The socially awkward behaviour was definitely part of the aura because it was shortly after that that I discovered head pain, nausea and feeling not right with the world. The whiny, querulous behaviour could well be ascribed to the pain experience, though with an already identified aberration in behaviour, it is equally as likely to be a component of the migraine event.

So now I wonder, because not all migraine events occur with an identifiable headache or other physical manifestation that can be pointed to and said, ‘I feel unwell’, is it possible that some behaviours that seem a little inappropriate or socially unacceptable from usually ‘normal’ people, are actually a migraine event?

I search Dr. Google without effect. I can find triggers, symptoms and now evidence of genetic transmission, but little on the possibility of behaviours as a component of the attack. One article mentions over 70% of headache sufferers report interpersonal relationships are impaired. Mymigraineconnection answers a question about behaviours with a usual online caution to discuss with a doctor, but at least someone else is asking the question.

The search leads to Anatomy of a Migraine, which provides a wonderfully succinct overview of migraine events as much more than headaches. And there I discover some things I didn’t know about migraines despite having the experience for many years. All those things that I often just chalk up to the weirdness of being me, well they are also a part of the prodromal migraine experience.

Does this help me? Well, maybe yes, maybe no. I would still like to know the Why of the event, but at least now I can point to a Why of some of the other things that are also being experienced frequently. I still want to know why after years and years of freedom from bad migraines they have resurfaced. I can wander through life yawning, and dizzy, but behaving oddly does not give me comfort.

Although, on retrospect of being a heretic, perhaps I should embrace the oddity of being me, run with the wind and just tie a crocodile to my head.

Four years ago on this date the world became a much scarier place. My world shattered and I just knew it would never be OK again. My father died that day four years ago and like millions of other children who experience the death of a parent, I felt alone, frightened and suddenly 6 years old again.

Grief is a funny thing. It tears you wide open and leaves you raw, weeping and unable to gather your insides back into the safety of your body. The world shift a step to the left and you move through places and activities feeling that step out of time. The first six months after my father’s death are gone from my life. I can’t remember anything much about that time other than I was struggling. I made mistakes, could not focus and likely did a terrible job at work. I was fortunate to have a very supportive boss – I got a month off for bereavement leave. There is no way I could have stepped into an emergency room or the PICU before then.

When I did return to work it wasn’t too long before I was face to face with an older man who was experiencing some vague respiratory distress. He didn’t look right although he had been triaged as a 3. I can’t remember how long he had languished in the waiting room, but by the time I got him he was rapidly deteriorating and was in the wrong area for care.

Triage is a tricky process. Originally developed in WWI to filter out who will live regardless, who will die regardless and who will live if given treatment, it is a necessary component of our emergency system. Everyone traiges you from the first health care provider to the last, but in the ER it is a formal defined part of your admission to the world of health care. It is a very useful tool, especially in the hands of a skilled provider, for situations where you have mass numbers of people all needing care now, and all needing different levels of care.

The Canadian triage system (CTAS) categories you according to injury and physiological findings with scores from 1-5 (1 being emergent intervention required now, 5 being could wait days and still be OK). As with every triage system there are problems. While using physiological evidence helps sort out the truly ill from the truly melodramatic, it still does depend upon what the patient says is the reason they have come to the emergency. A complaint of “I can’t breathe” along with sats of 85%, respiratory rate of 24 with signs of laboured breathing and a heart rate of 120 will get you a higher score in traige than the same complain with a normal respiratory rate, sats and heart rate. The problems come with the vague patients. “I don’t feel well” is not a helpful complaint to arrive in the ER with. The traige nurse has a few minutes to determine what is the best thing to do with you – yes, ideally it would be to get you back onto a bed where you can sit and watch the daily ER drama unfolding, BUT, there are several other people with much more life threatening complaints also in need of the same bed sapce and provider care.

A big problem though is that wait after traige for the bed. Patients in the waiting room can and do deteriorate. ER waiting rooms were not designed to make you all clearly visible to the staff at the traige desk. There are often hidden nooks and cranies and often very sick people will, like ill animals everywhere, seek to isolate themselves in one of those hidden nooks.

Back in my pod, I give the patient a fast look and listen, I slapped on O2, paged the ER physician and ran an EKG. When the physician arrived we ran the patient over to the A pod where I gave a very abbreviated report to the recieving RN which several others prepared to intubate him, started IVs, got blood work, ordered medications and basically went about the work of saving his life.

I went back to work, seeing the walking wounded of the world, and at teh end of shift, slipped back in to see the man before I went home. He was all alone in his cubicle, still not intubated but breathing better. He looked scared. He had glimpsed behind the mysterious veil that follows us all around. He was alone and frightened. I knew how he felt, but more, because my father had died in an ER just a few months early, I was afraid for him. I wanted him to be alright. I hadn’t been there for my dad so I held this man’s hand and told him they would take good care of him and he would be OK.

I had said he words we know not to say. “You will be OK” I needed to give him reassurance and comfort because he was afraid, but mostly, I needed him to be OK, because I was afraid he would not be. I was afraid he would die, just like my dad, in the ER. And so, for my own comfort, I gave the patient what I needed to be true.

We are human afterall, with the same fears and needs as those on the stretcher. Most of the time we can seperate ourselves from our patients. We are caustioned to develop this at all costs, but I wonder, often if this is really the best approach. Patients need and want us to see them as individuals. They need us to conect, on a huma level, just for a few minutes during our inspection , pokings and prodings of orifices. They let us in to their most intimate circle of life and we often fail them by not recongizing this and by remaining at a distance. It takes so little to hold a hand and offer the human recogniztion of the individual and the need for him to be OK. He has worth, and we care.